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ELE+�TR�CAL PERMIT APP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.gov <br />i�� �-� .��,, C-nw�� t �- �� °►�203 <br />� :UJECT ADD ESS <br />7 �3���5 <br />e �so�.. a33 <br />1�Y,�.1� N��nl��, 101� S1�1Cf1�1��� t� �t2�ii �1- �4���3 '��'0=L?3-o�i <br />Owner Mad Address City Slate/Lp Phone <br />Tenant <br />L'1 <br />Mall Address <br />�� <br />Cny <br />RI <br />SlatelLip <br />Phone <br />/' <br />1���:1'1��1�� �l � 3 I 3 i� A�t St �"t�L�T w�- �lt�2u� �- 32�-2�.c�U� <br />Electrical Co�iractor tvSa�l Atldress Cdy Stale2ip Phone <br />�P r��-nE�i � a �� <br />S�a�c License Number (reqmred) <br />z�s � a���� <br />Pioposed Usc ol Butlding <br />�� � � <br />Square Foo age Qt resideNial new conslruction, remodel or addilion) <br />� <br />Number ol devices Qf low voltage) <br />��q 3� � <br />City al Evcrett Business License Number (required) <br />.� �_ q o a� <br />CoMrect Price o1 Work <br />��� a25-3'L"1-2intY1 <br />Contact PersoNConlact NumbedEmnil <br />h��'h�\ �1��liUS�Urv�,C <br />Description of Work to Oe Done� f—l7 L(1 ��� ��1 I 1�� �.i����— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily fhal I have read 'und exannnr.d fhis npplica6an and knowlhr, sarne fn be Inie and <br />CORG`Cl. All �)/UVISIOIIS O� �aws and nrrhnancr.s govemmg fhis lype ol work wdl Ge complefed <br />whefhcr spr.cilicd herein or nol Thc granfmg o/ a penmf Jor.s nof presume fo yrve aufhonty lo <br />violale o� canccl lhe pmvc:ions ol ony olhr. i slnte or for.�il !aw regulahng consln�clion orlhe <br />pmfonnance oI consfnicfion Ihnf 1 mn n�dhorved by Ihe owner o/ (his pmperfy to pedortn thr. <br />wo�k lor which appl�cation is rnadc and 1 cornpty wi!h fhr. Slafc Contmr.lors La�v 18.27 RCW and <br />296.200 WAC j <br />��' �"����5 <br />Si na'r��e Date <br />rn. visr n nrvmra u <br />FEE <br />� � po <br />PERMIT71 <br />E I�D� - 23 .'� <br />